Travis C. Burns, MD Sports Medicine and Shoulder Reconstruction Arthroscopic Shoulder, Hip, and Knee Surgery www.travisburnsmd.com https://ortho‐sa.com/ (210) 705‐5060

MICROFRACTURE TREATMENT OF ARTICULAR CARTILAGE DEFECTS (Patellofemoral)

General Guidelines

 Obtain full extension within 2 weeks after surgery  Crutches for 6 weeks, TTWB  No brace  Begin using stationary bicycle within 3 days of surgery  Return to sports at 4‐6 months

Post‐op Days 1 – 14 Goals: Bicycle for 15 minutes daily starting within 3 days of surgery, full extension, obtain good quad control  POD 2: Change dressing, keep wound covered, continue TED Hose  POD 10‐14: Sutures out, D/C TED Hose when effusion resolved  Brace – Locked in extension for 6 weeks  Crutches – Toe touch weight bearing (TTWB) Therapy: AAROM, AROM as tolerated Passive extension with heel on bolster or prone hangs Patellar mobilization (teach patient) Calf pumping Short arc quads, 0‐20 only, without resistance Standing HS curls in parallel bars Straight (SLR) x 4 with knee in brace Electrical stimulation in full extension with quad sets and SLR Stationary bicycle for ROM, seat adjusted high, no resistance No Resisted Closed Chain ex x 6 weeks No Resisted Open Chain ex x 6 weeks

Weeks 2 – 4 Goals: No effusion, no extensor lag Therapy: Crutches with TTWB x 6 weeks Continue appropriate previous Scar massage when incision healed D/C CPM once patient is independent with stationary bicycle AROM, AAROM as tolerated Co‐contractions quads / HS at 0, 30, 60, 90 degrees SLR x 4 on mat – Add light weight below the knee if good quad control Pool therapy – Deep water (chest/shoulder) walking and ROM exercises – Water jogging floating upright in deep water Stretches – , hip flexors, ITB

Weeks 4 – 6 Goals: Full ROM Therapy: Crutches TTWB Continue appropriate previous exercises PROM, AROM, AAROM to regain full motion Standing SLR x 4 with Theraband (standing on uninvolved LE)

Weeks 6 – 8 Goal: Normal Gait Therapy: Weight bearing as tolerated (WBAT), D/C crutches when gait is normal Continue appropriate previous exercises with light weight Mini squats, Wall squats Hamstring curls – Carpet drags or rolling stool (closed chain) Treadmill – Forwards and backwards walking

Weeks 8 – 12 Goal: Walk 2 miles at 15 min/mile pace Therapy: Continue appropriate previous exercises HS curl weight machine Knee extension weight machine Proprioceptive training – BAPS, ball toss, body blade Fitter Slide board Forward, lateral and retro step downs Stationary bike – Minimal resistance Treadmill – Walking progression program Elliptical trainer Pool therapy – Waist deep water walking or slow jogging Quad stretches

Months 3 – 6 Goals: Return to running and full activities Therapy: Continue appropriate previous exercises with progressive resistance Treadmill – Running progression program Agility Drills Sit‐up progression Stairmaster

Months 6 ‐ 9 Goals: Walk 2 miles at 15 min/mile pace Therapy: Continue appropriate previous exercises with increased resistance – Progress to 90 degrees of knee flexion – Increase resistance as tolerated Hip weight machine x 4 bilaterally Step downs with medium to large steps Sit‐up progression Progressive program Treadmill – Running progression program

Knee Post Op Phase 1 Perform exercises below frequently: 30 reps 3-5x a day

Quad Isometrics

Heel Slides

Active Assisted Motion

Ice Position 15 minutes 2-3 x per day